Republican presidential candidate John McCain wants health insurance companies to compete for your business on the open market.

He would offer families a $5,000 tax credit to help buy insurance policies.

“Millions of Americans would be making their own health care choices again,” McCain said in remarks prepared for delivery Tuesday at the H. Lee Moffitt Cancer Center & Research Institute in Tampa.

“Insurance companies could no longer take your business for granted, offering narrow plans with escalating costs,” he said. “It would help change the whole dynamic of the current system, putting individuals and families back in charge, and forcing companies to respond with better service at lower cost.”

His campaign called the speech a major policy address, though McCain has talked about the same ideas for several months. What’s new, according to adviser Doug Holtz-Eakin, is that McCain will give more examples of how his policies would work.

Still missing: The total cost of the plan and an estimate of how many people it would help. There are more than 40 million people in the United States who don’t have health insurance.

“So, a little more detail, but remember, it is April, and the election’s in November, so not everything will happen tomorrow or this week,” Holtz-Eakin told reporters Monday.

Under McCain’s plan, anyone could get the credit, and those who like their company health care plan could choose to stay in it. The credit would be available as a rebate to people at lower income levels who have no tax liability, Holtz-Eakin said.

To pay for the tax credit, McCain would eliminate the tax exemption for people whose employers pay a portion of their coverage, raising an estimated $3.6 trillion in revenues, Holtz-Eakin said. Companies that provide coverage to workers still would get tax breaks. McCain would also cut costs by limiting health care lawsuits.

The goal is to move the health care industry away from job-based coverage toward competition among health insurance companies on the open market.

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Requires everyone to have insurance. Insurers must sell to all who apply. Large employers would offer coverage or pay a portion of workers’ costs. Small employers would be exempt but could get tax incentives to provide coverage. A new public plan, “Health Choices Menu,” similar to the federal employees’ program, would be designed. A refundable tax credit would help pay for coverage. Premiums’ cost would be limited to a percentage of income. OBAMA

Requires all parents to have coverage for their children. Insurers must sell to all who apply. Large employers would offer coverage or pay into a fund. Small employers would be exempt but could buy coverage in a new system with subsidies available to some businesses. Creates a new plan for the uninsured and businesses that is similar to the federal employees’ health program. For employers who offer insurance, the government would pay for very expensive care, if employers agree to pass savings to workers. McCAIN

Ends tax-free health benefits offered through employers and replaces with a tax credit of $2,500 for individuals and $5,000 for families to purchase health insurance. Allows consumers to buy insurance from sellers in any state, which could be cheaper. Allows businesses and the self-employed to band together to buy insurance through associations, which they cannot do now in some states. Sets limits on medical malpractice awards. Allows importing prescription drugs from other countries. The cost Estimated $110 billion a year when phased in. Would be offset by cost savings, such as limiting tax-free health benefits for those earning more than $250,000 and ending recent tax cuts that income group received under President Bush. Estimated $50 billion to $65 billion a year, with much of the cost coming from savings in the health system and ending tax cuts for those making more than $250,000 a year. The campaign has not estimated costs. Sources: USA TODAY research and the Kaiser Family Foundation ]]> http://blog.mossbenefits.com/2008/04/07/side-by-side-comparison/feed/ http://blog.mossbenefits.com/2008/03/27/surprise-family-practitioners-switch-to-boutique-care/ http://blog.mossbenefits.com/2008/03/27/surprise-family-practitioners-switch-to-boutique-care/#comments Thu, 27 Mar 2008 20:06:00 +0000 Jon Moss http://blog.mossbenefits.com/2008/03/27/surprise-family-practitioners-switch-to-boutique-care/ Washington Post
March 18, 2008

Between now and next month, Lou Bruhn, 65, of Fairfax County will have to make an important decision about his medical care: Should he pay $1,500 a year to stick with his primary care physician of three years — a doctor who he says has given him excellent care? Or should he resign himself to finding another doctor?

Some 5,000 Northern Virginia residents are mulling the same question after learning that their Franconia family practitioners, Brett Wohler and Andrew Wise, are switching to what’s sometimes called boutique, or concierge, care. On April 15, the pair will join a national doctors’ network and will charge each patient an annual retainer of $1,500. In return, the physicians say they will offer more attention, including round-the-clock cellphone access, same-day appointments and time to accompany their patients to specialists.

The move follows a nationwide trend that began nearly 12 years ago as a reaction to what some doctors see as the excesses of managed care. More than 1,000 doctors have switched to this mode of practice, according to the Society for Innovative Medical Practice Design, a trade group in Richmond.

Under concierge plans, doctors typically reduce the size of their practice so they can stretch patient visits to 30 minutes, compared with the seven to 16 minutes that various studies have found to be average under managed care. In addition to their annual retainers, doctors collect the usual fees for service or reimbursements from patients’ health insurance plans. The doctors also accept Medicare patients.

Proponents say concierge care lets doctors give patients the time and services they deserve, and allows them to focus more on preventive care. But critics say the development exacerbates inequities in the American health-care system by limiting access and increasing the workload of doctors who don’t join such networks.

Several years ago, only a handful of Washington area doctors listed themselves as members of MDVIP, the nation’s largest retainer health-care company and the one Wohler and Wise are joining. By June 1, the area will have nearly two dozen MDVIP doctors, according to company officials, with 15 in Northern Virginia, six in Maryland and one in the District.

“It’s not really about the money; I can afford it,” said Bruhn, a retired engineer and a patient of Wise’s. “I guess I’m still curious to see if it works as well as the doctors seem to believe, and if that would be worth the price for me.”

But some other patients are less sanguine.

To convert to the new plan, Wohler and Wise plan to drop about 4,000 of their 5,000 patients. Remaining patients, up to 1,000, will be selected on a first-come, first-served basis, they say, leaving the rest to find a new physician they can trust.

Lisa Zuber, 51, of Springfield, is one of them. A patient of Wohler’s since 2004, she said that she initially considered following him into his new plan. But the more she learned about concierge care, the more it made her uncomfortable.

“I guess what bugs me so much is that even if everyone wanted to join, they couldn’t,” said Zuber, an administrator for a national professional association. “It sets up this situation where people are competing against each other to get health care. I just didn’t want to be a part of that.”

Wohler voiced regret about the situation. “There are patients that I’ve seen for years that probably will not continue, and that’s hard,” he said in an interview last week. “Part of me asked myself, ‘Is this right?’ But I firmly believe I’ll be getting back to doing the things that I set out to do when I first became a doctor.”

MDVIP requires doctors like Wohler to help each of his patients find a new primary care physician, and they don’t stop seeing them until they do.

Last week about 50 patients attended an information session in Springfield hosted by Wohler and Wise, complete with a video touting the benefits of the program. Here, too, patient views were mixed. “I’m absolutely going to join,” said Arthur Smith of Fairfax County. “There doesn’t seem to be any drawback.”

Others were more cautious.

“It makes you wonder where we’re going as a health-care system,” said a patient of Wise’s, who identified himself only as Ray and declined to give his last name. “I understand where these doctors are coming from — all the paperwork they have to fill out, no time with patients. . . . It can make you feel like you’re really not doing your job.”

Doctors and medical ethicists across the country continue to debate the trend toward concierge medicine.

In a policy statement several years ago, the American Medical Association said that while retainer contracts offer viable options for care, “they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

Even short of that, some have expressed concern about limiting access to care for poorer, sicker and nonwhite patients.

A 2005 survey of 144 retainer doctors in the Journal of General Internal Medicine found that such practices had far fewer minority and Medicaid patients than non-retainer doctors.

“This really isn’t a solution to the chief problem in our health-care system, which is maldistribution,” said Jay Jacobson, chief of the division of medical ethics and humanities at the University of Utah School of Medicine, who wasn’t involved in the survey. “By giving more people an opportunity to opt out, they’re not addressing the problem of access to health care.”

Others have questioned how much impact retainer practices are having. The 1,000 or so retainer physicians, they say, are few compared with the more than 280,000 primary care physicians nationwide.

“Reasonable people can disagree about the practice, and they certainly have been a lightning rod for controversy,” said G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, who co-authored the Journal of General Internal Medicine study. “But it’s unclear to me how viable the market is right now.”

Dental Implants:   Beginning April 2008, dental implants will be covered in many UnitedHealthcare Dental plans. Implants provide artificial teeth that look and feel natural. Implants are a surgical procedure requiring patients to be in good health, have healthy gums, and have adequate bone to support the implant. With a commitment to meticulous oral hygiene and regular dental visits, dental implants can last a lifetime.

Oral Cancer Screening:   United Healthcare is also enhancing many of their dental plans to cover new non-invasive technology used to screen patients for oral cancer.

This puts UnitedHealthcare Specialty Benefits on the leading edge of the “Wellness” trend, focusing on research-based programs and enhancements that show a connection to improved health outcomes. Experts agree that every adult should have an oral cancer exam at least once a year. 

This new technology improves the dentist’s ability to identify, evaluate and monitor lesions that are difficult to see under conventional lighting. This quick and entirely pain-free exam makes dentists the first line of defense in fighting this deadly disease

 The AARP results are troubling to many community and insurance industry leaders.  If people mistakenly believe that public programs will step in and cover long-term care, they won’t make arrangements for private care–and they may end up with no long-term care at all.

In a recent blog post, Rep Dan L. Burton, R-Indiana, called the AARP report findings “shocking,” and he encouraged future legislative change to help educate the public about long-term care policies and coverage options.

“With only 10% of seniors currently covered under private long-term care insurance policices to help cover long-term costs, the average cost of a private room in a nursing home running about $75,000 a year, and our nation’s baby boom generation beginning to retire, we are literally facing a huge health care train wreck,” Burton warns.

According to the U.S. Department of Health and Humana Services, the number of recipients age 65 or older in need of long-term care may increase to 12 million by the year 2020.

The measure is an expansion of Como’s investigation into reimbursement practices of health insurers.

We previously blogged that New York’s attorney general planned to sue Minnetonka-based UnitedHealth Group (NYSE: UNH) and its subsidiary Ingenix, calling the insurer part of an industrywide effort to defraud consumers by manipulating reimbursement rates.

In February, Cuomo’s office issued 16 subpoenas to health insurance companies including Aetna, Cigna and Empire BlueCross BlueShield as part of a six-month investigation into how the insurance industry handles reimbursements for physicians who are outside of a health plan’s network.

A spokesman for Cuomo’s office told Bloomberg News that it has issued another 20 subpoenas that included demands for depositions of the CEOs, including those at Cigna Corp, Aetna, and WellPoint Inc., the news service reported.

A spokesman for UnitedHealth told Bloomberg, “We’ve been in ongoing discussions with the attorney general and we are continuing to cooperate fully.” UnitedHealth has refused to specifically confirm or deny the subpoenas.

Democrats who apposed the plan are worried that individuals who obtain the limited plans will not truly understand the coverage of the plan and will only make their decision to purchase based solely on price. Democrats predict that the future of this plan is flawed because its popularity may grow tremendously in the future but coverage will not be sufficient for most.

Clinton’s rival, Barack Obama, says it is unfair to force people to buy insurance they can’t afford and argues that most people would buy insurance if the cost is reduced. In recent weeks, the National Small Business Association, the National Business Group on Health — representing large employers — and the National Retail Federation have endorsed an individual mandate. The National Federation of Independent Business has not taken a position. The NFIB helped kill Clinton’s 1993 health care plan because it required all employers to provide insurance.

The U.S. Chamber of Commerce opposes an individual mandate, as well as an employer mandate. Both Clinton and Obama would require employers to provide health insurance or contribute to their coverage by paying money to the federal government. Both would exempt small businesses from this mandate, but they haven’t specified what the size threshold for that exemption would be. They also would provide subsidies or tax breaks to low- and moderate-income individuals to help them buy insurance. Likely Republican nominee John McCain opposes mandates. His health care plan focuses on reducing health care costs

The initiative also opens a new front in Google’s spreading confrontation with Microsoft. The software company launched its own personal health records system, known as HealthVault, late last year.

Eric Schmidt, chief executive, outlined the Google Health plans at a conference in Florida on Thursday. The system will be based on personal health records that patients authorise their health insurers, doctors and others to move into Google’s database.

Other companies will then be able to write software applications that make use of these data, for instance creating services that help patients manage their medications or warn parents when their children need inoculations.

“There are a lot of applications you can’t envisage today,” Mr Schmidt told the Financial Times, adding that the overall aim was to improve the health of users by improving the quality of care.

That “platform” strategy could one day make the Google database the foundation of a more automated health information service. “We hope to get partnerships with all the health companies, so that if you have a prescription we just suck it straight in,” Mr Schmidt said.

Personal health record systems are not new, but the idea has been slow to catch on since there have been few incentives for doctors to automate health records or for patients to try to draw all their personal information together in one database.

The biggest incentives for people to use the new system include the ability to take control of their own records when they change health insurers or doctors, Mr Schmidt said. Also, patients who obtain drugs from more than one pharmacy will benefit if their records are consolidated in one place, he added.

For now, Google has no plans to sell advertising around the health service, Mr Schmidt said. Instead, it hopes to raise awareness of the Google brand and encourage greater use of its search engine.

-FT

According to the Department, UnitedHealth must sell portions of its business first to ensure competition.

Although UnitedHealth has agreed to those conditions, the DOJ’s antitrust lawsuit cited concerns that the merger would reduce competition in the Medicare health insurance market in Nevada, according to reports.

The Department’s proposal, which must be approved by the court, asks that UnitedHealth sell portions of its Medicare Advantage business in the Las Vegas-area for the merger to proceed, according to reports.

Otherwise, officials with the Department argue, the new company would control 94 percent of the Medicare Advantage market in that area.